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General NPI Number Information
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NPI Number | 1194770669
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Entity Type | Organization
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Legal Business Name | BAYOU LA BATRE AREA HEALTH DEVELOPMENT BD.INC.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1340 NORTH WINTZELL AVE.
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City | BAYOU LA BATRE
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State | AL
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Zip | 36509
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Country | US
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Telephone | 251-824-2347
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Fax | 251-824-4337
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Provider Business Mailing Address
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Address Line | PO BOX 769
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City | BAYOU LA BATRE
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State | AL
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Zip | 36509-0769
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Country | US
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Telephone | 251-824-2347
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Fax | 251-824-4337
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES A. HOLLAND
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Credential | MPH
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Telephone | 251-824-2174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2006-293
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License Number State | AL
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